PHLT 313 Exam 1 tamu exam with correct answers 2024

What is the focus of public health? - answer-people (population health, community health, prevention) also focuses on prevention! What does someone in public health do? - answer-Everyone does different things. -Environmental health, epidemiology, occupational safety and health, policy makers, educators, scientists, etc. Public health - answer-The science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, control of community infections, and education of individuals regarding hygiene to ensure a standard of living for health maintenance -An organized community effort to address public health by applying scientific and technical knowledge to promote health -BOTH definitions involve the COMMUNITY Examples of PH professionals: - answer-Environmental health scientists Biostatistics (Statistics uses numbers (samples) to make inferences about the population) Epidemiologists Emergency preparedness personnel Etc. Public Health 10 Essential Services: - answer-○ Monitor health ○ Diagnose and investigate ○ Inform, educate, empower ○ Mobilize, community, partnership ○ Develop policies ○ Enforce laws ○ Link to/Provide care ○ Assure competent workforce ○ Evaluate ○ Research Public Health System - answer--Assesses and promotes health and safety -Prevents or minimizes the occurrence of disease and injuries -Plans, prepares and responds to natural and manmade disasters -Identifies barriers, and facilitates access to primary and preventative health care (Ex: Socioeconomic status, language, money can be barriers) -Enforces public health laws and regulations § Primary focus on population/community § Emphasis on disease prevention and health promotion Public Health Achievements - answer-○ Immunizations ○ Motor-vehicle safety ○ Workplace safety ○ Control of infectious diseases ○ Declines in deaths from heart disease and stroke ○ Safer and healthy foods ○ Healthier mothers and babies ○ Family planning ○ Fluoridation of drinking water ○ Tobacco as a health hazard What is health to you? - answer-State of complete physical, mental, and social well-being are not merely the absence of disease or infirmity - WHO Who are the health care professionals? - answer-Nurses, nurse practitioner, doctors, PAs, etc. Health Care System - answer-Include: Healthcare team, patients, community resource providers - Also, Insurance providers, government, home health care, alternative medicine (chiropractor, massage therapist, etc.), policies/laws § Primary focus on individual § Emphasis on diagnosis and treatment System - answer-is a network with many components inside National Health Expenditures - answer-2014, US health care spending is approx. 3.0 trillion US dollars -~$9,523 per person -Amount increases -Most money goes to inpatient and outpatient services (hospital care and physician and clinical services) Insurance coverage by race/ethnicity in 2014 - answer--Uninsured overall went down due to Affordable Care Act -Hispanic and American Indian/Alaska Native are most uninsured § Basically, minorities are more uninsured Compared to other countries (that are similar to us, not underdeveloped countries), - answer-In the US, we spend a lot more compared to other countries What is a "population?" - answer-The whole number of people or inhabitants in a country or region The total of individuals occupying an area or making up a whole Population health - answer-The health outcomes of a group of individuals, including the distribution of such outcomes within the group § Morbidity, mortality, health and well-being of a defined group of people § Ex: Looking at health outcomes of the Hispanic population What makes some people healthier than others? - answer-Education, socioeconomic status, genetics, behavior (exercising), employment Determinants of health fall under several categories: - answer-§ Policymaking § Biology and genetic factors § Individual behavior § Social factors § Environmental factors Individual lifestyle factors - answer-Exercise, sexual activity, and diet Other general macroenvironmental conditions of socioeconomic, cultural, and environmental conditions that impact health - answer-§ Education § Work environment § Living and working conditions § Healthcare services § Food production § Water and sanitation § Housing Physical environment - answer-Connection between health and the environment (Water, food, milk sanitation)(Improve nutrition) Could deteriorate without adequate support of the governmental public health Environmental health problems - answer-Global warming, population growth, habitat destruction, loss of green spaces, places in which people work and live, rural vs. urban NOT an easy fix, requires the whole community/govt to come together to fix the problem EX: Hurricane disasters Problems with places in which people work and live: - answer-Tobacco smoke Pesticides Toxic housing: Lead-based paint, asbestos-containing insulation Urban vs. Rural - answer-Exercise Air pollution Diet Hurricane disasters - answer-Flooding, power outages, water supplies, food and water safety, shelter, clean up Social determinants of health - answer-Neighborhood and built environment, health and health care, economic stability, education, social and community context Socioeconomic status (SES) - answer-Social standing or class of an individual or group -In general, socioeconomically advantaged people have lower mortality, morbidity, and disability rate -Strongly related to access to and the quality of preventative care, ambulatory care, and high-tech procedures □ Education □ Income □ Occupation Socioeconomic status vs. health - answer-Studies examined association between SES and health • SES is strongly related to access to and the quality of preventive care, ambulatory care, and high-technology procedure Social connectedness - answer-Complex relationships between individuals and among groups -Strong social ties can have a direct and positive impact on health Higher level of perceived social connectedness: - answer-Lower blood pressure rate Better immune responses Lower levels of stress hormones Classification of population-level preventive measures - answer-Universal preventive measure Selective preventive measure Indicated preventive measure Universal preventive measure - answer-Recommended for everyone in an eligible population -May be more optimal and cost-effective than interventions targeted further downstream (Tobacco use prevention, automobile-related injury prevention population-based strategies) Selective preventive measure - answer-Recommended only when an individual is a member of a subgroup of the population whose risk of becoming ill is above average Indicated preventive measure - answer-Applicable to person who, on examination, manifest a risk factor, condition, or abnormality that identifies them individually as being at high risk for the future development of a disease Chronic disease - answer-Often been less of a priority for public health and health organization -Not a one agency job! Institute of Medicine. The Future of Public Health, 1988 - answer-In recent years there has been a growing sense that public health as a profession, as a governmental activity, and as a commitment of society is neither clearly defined, adequately supported, nor fully understood -current capabilities for effective public health action are inadequate -By its very nature, public health requires support by the public, its beneficiaries Origin of Public Health Core Function & Essential Services - answer-The Future of Public Health (IOM, 1988) led to Public Health core functions led to Formulations characterizing PH practices led to Development of Essential public health services 3 core functions of public health: - answer-Assessment, policy development, assurance Assessment - answer-Monitor health, diagnose and investigate, research Policy development - answer-Inform, education, and empower, mobilize community partnerships, develop policies, research Assurance - answer-Enforce laws, link to/provide care, assure competent work force, evaluate, research 10 Essential Services - answer-Evaluate, monitor health, diagnose & investigate, inform educate empower, mobilize community partnership, develop policies, enforce laws, link to/provide care, assure competent workforce Essential Services as a Framework - answer--Provide a foundation for any public health activity -Describe public health at the state, tribal, local, and territorial levels -Used as a foundation for the National Public Health Performance Standards (NPHPS) -Provided structure for national voluntary public health accreditation Monitor Health (ES1) - answer--Accurate, periodic assessment of the community's health status --Identification of health risks, attention to vital statistics and disparities, identification of assets and resources -Use of methods and technology (e.g., mapping technology) to interpret and communicate data -Maintenance of population health registries Diagnose & Investigate (ES2) - answer--Timely identification and investigation of health threats -Availability of diagnostic services, including laboratory capacity -Response plans to address major health threats Inform, Education and Empower (ES3) - answer--Initiatives using health education and communication sciences to: --Build knowledge and shape attitudes --Inform decision-making choices --Develop skills and behaviors for healthy living -Health education and health promotion partnerships within the community to support healthy living -Media advocacy and social marketing Mobilize Community Partnerships (ES4) - answer--Identification of system partners and stakeholders -Constituency development -Coalition development -Formal and informal partnerships to promote health improvement Develop Policies (ES5) - answer--Policy development to protect health and guide public health practice -Community and state improvement planning -Emergency response planning -Alignment of resources to assure successful planning Enforce Laws (ES6) - answer-• Review, evaluation, and revision of legal authority, laws, and regulations • Education about laws and regulations • Advocating for regulations needed to protect and promote health • Support of compliance efforts and enforcement as needed Link To/Provide Care (ES7) - answer-• Identification of populations with barriers to care • Effective entry into a coordinated system of clinical care • Ongoing care management • Culturally appropriate and targeted health information for at risk population groups • Transportation and other enabling services Assure Competent Workforce (ES8) - answer-• Assessing the public health and personal health workforce • Maintaining public health workforce standards --Efficient processes for licensing /credentialing requirements --Use of public health competencies • Continuing education and life-long learning --Leadership development --Cultural competence Evaluate Health Services (ES9) - answer-Evaluation must be ongoing and should examine: -Personal health services -Population based services -The public health system Quality Improvement Performance Management Research (ES10) - answer-• Identification and monitoring of innovative solutions and cutting-edge research to advance public health • Linkages between public health practice and academic/research settings • Epidemiological studies, health policy analyses and public health systems research Federal Public Health Responsibilities - answer-• Essential public health services • Act when there is wide spread • Find solutions beyond individual states • Support state with emergency responses • Facilitate formation of PH goals • Leadership • Operational and financial resources • Research and education US Dept. of Health and Human Services (HHS) - answer-The most important agency at the federal level Federal Level of Public Health Agencies - answer-US Dept. of Health and Human Services (HHS) Center for Disease Control and Prevention (CDC) The Agency for Toxic Substances and Disease Registry (ATSDR) National Institutes of Health (NIH) US Food and Drug Administration (FDA) The Substance Abuse and Mental Health Services Administration (SAMHSA) Indian Health Services (HIS) State and Local Health Departments - answer-Retain the primary responsibility for health under US Constitution -State and the District of Columbia Health Dept., Tribal Health Dept., Local Health dept., Territorial Health Dept. State Roles - answer-§ Screening for diseases and conditions § Treatment for diseases § Technical assistance and training § State laboratory services § Epidemiology and surveillance Texas Health and Human Services - answer-In Austin (Capitol) -In charge of actual activities going on here State and Local Health Department Governance Classification System - answer-Local/Decentralized, Mixed, State/Centralized, Shared Local/Decentralized - answer-Local health departments are units led by local government, which make most fiscal decisions -Texas is a local governance type (does not mean it can't be shared or mixed) Mixed - answer-Some local health dept are led by state government and some are led by local govt State/Centralized - answer-All local health dept are units of state govt which makes most fiscal decisions Shared - answer-All local health departments are governed by both state and local authorities Most frequent activities of Local Health depts - answer-§ Adult immunization § Communicable/Infectious disease § Child immunization § Tuberculosis screening § Food Service Inspection § Environmental Health Surveillance § Food Safety Education § Tuberculosis Treatment § Schools/Daycare Center Inspection § Population-based Nutrition Services (in order from highest frequency to lowest) Public Health Challenges in the US Insular Areas - answer-○ Geography ○ Culture ○ Economy ○ Education ○ Morbidity and mortality Tribal Health Department - answer-a corporation or organization operated under the jurisdiction of a federally recognized tribe, or association of federally recognized tribes, and is funded by the tribe(s) and/or contract service(s) from the Indian Health Service (IHS). Tribal Health Organizations - answer-oTribal Health Departments oIndian Health Service Units oArea Indian Health Boards and Urban Indian Health Centers (a much broader group, and relates to a variety of entities that might provide health services in a tribal setting) What are the US Insular Areas? - answer-The 5 US territories • Puerto Rico • Guam • US Virgin Islands • American Samoa • Commonwealth of the Northern Mariana Islands The 3 Freely Associated States (sovereign nations in a Compact of Free Association with the US) • Republic of the Marshall Islands • Federated States of Micronesia • Republic of Palau How can federal public health address the unique challenges of the Insular Areas? - answer-Provide higher salary, free housing, something to entice people to come there A Well-Functioning Public Health System Has... - answer-• Strong partnerships • Effective communication • System-wide health objectives • Resource sharing • Leadership • Feedback A system of partnerships that includes, but is not limited to . . . - answer-Churches, schools, businesses, healthcare providers, environmental health, mental health, community services, transportation, community coalitions, justice and law enforcement, philanthropy, media -Our goal is an integrated system of PARTNERSHIPS between these Health care delivery and health services delivery - answer-In a broad sense, both terms refer to the: -Major components of the system -Processes that enable people to receive health care -Provision of health care services to patients Subsystems of US Health Care Delivery - answer-•Managed Care •Military •Vulnerable Populations •Integrated Delivery •Long-term Care •Public Health Managed care - answer-A system of health care delivery that: • Seeks to achieve efficiency • Control (manage) utilization of medical services • Determines the price -Most dominant health care delivery system -Primary financiers -MCOs function as an insurance company Enrollee - answer-people who are participating in the program Health plan - answer-contract between you and your health insurance company Gatekeepers - answer-someone who is making sure you are not getting something you don't need Ex: Family doctor (PCP) Military Medical Care System - answer-Veterans Administration (VA) health care system TriCare Available free of charge to: − Active duty military personnel: U.S. Army, Navy, Air Force, and Coast Guard − Certain uniformed nonmilitary services: Public Health Services and NOAA Veterans Administration (VA) health care system - answer-Begets over $40 billion Employed over 280,000 Organized into 23 geographically distributed Veterans Integrated Service Networks (VISNs) -Coordinate the activities of the facilities within jurisdiction One of the largest and oldest (1946) organized health systems in the world Available to retired veterans Hospital, mental health, and long-term care services TriCare - answer-§ Financed by US Dept of Defense § Covers active duty personnel, retirees, reservists & guard members called to Active Duty, and certain family members Characteristics of the military medical care system - answer-Well organized Highly integrated Comprehensive (covers everything) Covers preventative care Vulnerable populations - answer-AKA special populations -Those with health needs but inadequate resources to address those needs: § Poor, uninsured, minorities, immigrants, etc. § Also pregnant women, mentally disabled, etc. -Live in disadvantage communities and receive care from "safety net" providers: § Ex: ER, free clinics, community health centers, migrant health centers § Public health insurance programs: Medicare and Medicaid, Children's Health Insurance Program (CHIP) Safety net - answer-Support system that will provide a minimum support if something bad happens Integrated delivery system (IDS) - answer-○ A network/org that provides or arranges to provide a coordinated continuum of services to a defined population ○ Various forms of ownership and links among hospitals, physicians and insurers ○ Ex: Baylor Scott & White in Cstat Long-Term Care - answer-○ Medical and nonmedical care ○ Individuals who are chronically ill or who have a disability ○ By 2020, more than 12 million Americans are projected to require LTC Mission of public health system - answer-Improve and protect community health Key Characteristics of the US Health Care System - answer--No Central Governing Agency -Technology-driven and focuses on acute care -High in cost, unequal in access, and average in outcome -Imperfect market conditions -Government as subsidiary to the private sector -Market Justice and Social Justice: Conflict Throughout Health Care -Multiple players and balance of power -Quest for integration and accountability -Access to health care services selectively based on insurance coverage -Legal risks influence practice behaviors No Central Governing Agency - answer--Little integration or coordination -The U.S. system is different from other developed countries. --Not centrally controlled --Different payment, insurance, and delivery mechanisms --Financed both publicly and privately Technology-driven and focuses on acute care - answer-• Invests heavily in research and innovations in new medical technology • Demand for new services, despite shrinking resources • Overused, rising cost of health care High in cost, unequal in access, and average in outcome - answer-The US spends more than any other developed country on health care - Cost continue to rise at an alarming rate - But many have limited access to basic care High cost, average outcome = not worth it Access -The ability of an individual to obtain health care services when needed Who has access? - answer-1) Have health insurance 2) Able to pay out of pocket 3) Able to communicate 4) Know where to go Imperfect market conditions - answer-Under national health care programs: - Patients have varying degrees of choice in selecting providers - True "free market" forces are virtually nonexistent In a free market: - Multiple patients (buyers) and providers (sellers) act independently - Patients should be able to choose their provider based on price and quality • For the health care market to be free: - Unrestrained competition must occur among providers, on the basis of price and quality - Patients have information about the availability of services - Patients directly bear the cost of services received - Patients make decisions about the purchase of health care services WE DO NOT HAVE A FREE MARKET IN US Government as subsidiary to the private sector - answer-Private sector plays the dominant role • Government spending to fill in the gaps left open by the private sectors Market Justice and Social Justice: Conflict Throughout Health Care - answer-Contrasting theories that govern the production and distribution of health care services -Market justice- if you have the ability to pay, you receive the care, if you don't, you do not get care -Social justice- social welfare is collaborative work by the entire community, everyone's job to make sure you are healthy Multiple players and balance of power - answer-a. Key system players: i. Physicians ii. Administrators of health care institutions iii. Insurance companies iv. Large employers v. Government b. Different economic interest to protect c. Prevent any single entity from dominating the system Quest for Integration and Accountability - answer-a. Coordinate health services b. Accountability- you are responsible for your choices/actions --Hospitals must take responsibility for issues with care Access to health care services selectively based on insurance coverage - answer-a. Who gets medical care? i. Those who can afford to pay out of pocket ii. Those who have health insurance with adequate coverage b. What do others do? i. Safety net providers ii. Obtain treatment for acute illness at emergency depts iii. Pay out of pocket Legal risks influence practice behaviors - answer-a. Americans as a society are quick to engage in lawsuits b. Private health care providers are more susceptible to litigation and malpractice lawsuits c. Defensive medicine System foundations - answer-cultural, social, and economic factors that explain its current structure System resources - answer-both human and nonhuman resources in delivery health services System processes - answer-influence the development and change in physical structures System outcomes - answer-critical issues and concerns surrounding what the health services system has been able to accomplish (or not accomplish) System outlook - answer-project the future Basic models for national health systems: - answer--National Health Insurance -National Health System -Socialized Health Insurance System Canada - answer-National Health Insurance -The government finances health care through general taxes, but the actual care is delivered by private providers -Requires a tighter consolidation of financing, insurance, and payment functions, which are coordinated by the government Great Britain - answer-National Health System -Finance a tax-supported national health insurance program • The government manages the infrastructure for the delivery of medical care • Most of the medical institutions are operated by the government • Most health care providers are either government employees or are tightly organized in a publicly managed infrastructure Germany - answer-Socialized Health Insurance Systems - Health care is financed through government-mandated contributions by employers and employees - Health care is delivered by private providers - Sickness funds (private not-for-profit insurance companies) collect and pay for services - Delivery is characterized by independent private arrangement - Government exercises overall control System Framework - answer-• A set of interrelated and interdependent components designed to achieve some common goals • Explains the structure of health care services in the US base on the foundations • Provides a logical arrangement of various components • Demonstrates a progression from inputs to outputs PharmaCloud - answer-platform to manage all insured patients' medication history, and provide timely and comprehensive medication information to providers My Health Bank - answer-provide health records in the most recent three years, improve public understanding of health-related issues, etc. Beliefs, Values and Health - answer-Curative medicine has decreasing returns in health improvement with increased health care expenditures • Increase recognition of the benefits to society that can result from the promotion of health and prevention Belief and values remains mostly private − Not a tax-financed national health care program • Strong forces against fundamental changes • Social norms Different views of health: - answer--Medical/Biomedical − WHO − Holistic view Medical/Biomedical Model - answer-Health is the absence of illness or disease • Optimum health exists when: − A person is free of symptoms, and − Does not require medical treatment • Health care delivery: delivery of medical care or illness care • Indicator of lack of health: mortality or death WHO Model - answer-• "A complete state of physical, mental, and social well- being, and not merely the absence of disease" • Biopsychosocial model of health • Definition of health care system: All the activities whose primary purpose is to promote, restore, or maintain health Holistic Health - answer-Treats the whole person • Incorporates alternative therapies • Incorporate physical, mental, social and spiritual aspect • Studies show: • Religious & spiritual belief has a positive impact on overall well- being • It affects the incidence, experience, and outcome of common medical problems What model does US follow? - answer-US health care has followed a medical model -Presupposes the existence of illness or disease Illness - answer-Identified by a person's perception and evaluation of how he/she is feeling • People are ill when they show a diminished capacity to perform tasks and roles expected by society Disease - answer-Based on a professional evaluation • Requires therapeutic intervention Disease Classification - answer-Acute, subacute, chronic Acute - answer-§ Will happen rapidly without much of the symptoms Ex: Heart attack, asthma attack Subacute - answer-§ Something between acute and chronic Ex: Head trauma, acute (happened rapidly), but symptoms of concussion/injury can take a while to develop Chronic - answer-§ Will take a long time to develop Ex: Diabetes, asthma Quality of life - answer--Overall satisfaction with life during and after a person's encounter with health care delivery system -Very subjective, everyone has a different definition -Can be used in 2 different ways: 1. Satisfaction level while receiving health care services □ Comfort, respect, privacy, etc. 2. Overall satisfaction with life and self-perception of health Factors that influence an individuals and a population's health - answer-§ Genetic makeup (heredity) § Behavior and lifestyle § Medical care § Environment (pollution, quality of air/water, location (bad neighborhood)) § Socioeconomic status The U.S. has a unique system of health care delivery - answer-True The U.S. healthcare delivery system is complex and massive - answer-True In contrast to the US, most developed countries have national health insurance programs - answer-True All Americans are entitled to routine and basic health care services - answer-False Healthy People 2020 - answer-10-year plans outline key national health objectives Founded on the integration of medical care and prevention, health promotion and education Market Justice - answer-- Fair distribution of health care to the market forces in a free economy - medical services distributed on the basis of people's willingness to pay, those not able to pay have barriers to health care - emphasizes INDIVIDUAL responsibility for health Principles of Market Justice - answer-- health care is an economic good governed by free market force - people make rational choices in their decisions to buy health care products and services - people consult with their physicians - market works best without interference from government Social Justice - answer-- the equitable distribution of health care is society's responsibility - best when a central agency is responsible for the production and distribution of health care - should be collectively financed and available to every citizen Principle of Social Justice - answer-- heath care should be based on need rather than cost - shared responsibility for health - and obligation to the collective good Medical Care Determinants of Health - answer-- focuses primarily on treating illness or poor health - broad spectrum framework of medical care services and interventions to improve health 4 strategies of interventions - answer-- Social or Medical care policy - Community-based interventions - health care interventions - individual interventions